Rellán Ignacio, Donndorff Agustín Guillermo, Gallucci Gerardo Luis, Bronenberg Victorica Pedro, Holc Fernando, Abrego Mariano, Boretto Jorge Guillermo
Department of Orthopaedics, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Potosí 4215 (C1199ACK) Buenos Aires, Argentina.
Indian J Orthop. 2025 Apr 4;59(5):659-666. doi: 10.1007/s43465-025-01362-0. eCollection 2025 May.
Wide-Awake Local Anesthesia No Tourniquet (WALANT) has expanded its applications over the past decade from common hand procedures to a broader range of more complex surgeries. However, despite its frequent use, there is limited literature on WALANT for cubital tunnel syndrome. We have adapted the endoscopic technique reported by other colleagues to a mini-open approach. This approach is characterized by a smaller incision while preserving its blood supply. Our objective is to describe this two-stage local anesthetic injection method that has enabled us to safely and successfully treat 16 patients without complications.
We conducted a retrospective cohort study. Sixteen patients meeting specific inclusion criteria underwent ulnar nerve decompression under WALANT. Patients were preoperatively classified according to Dellon's classification. Surgical technique included a staged local anesthetic solution infiltration and careful dissection to preserve nerve stability.
Preoperative classification revealed six mild, six moderate, and four severe cases. Intraoperative discomfort was reported by four patients before incorporating a second stage of distal local anesthetic infiltration. All patients exhibited stable intraoperative ulnar nerve positioning and were discharged independently 20 min post-surgery. Follow-up at an average of 12 weeks (range 10 -18 weeks) showed symptom resolution in all patients. No complications, including iatrogenic injury to medial antebrachial cutaneous nerve branches, were reported.
This study demonstrates the feasibility and effectiveness of the WALANT technique for ulnar nerve decompression at the elbow. Incorporating a staged local anesthetic infiltration enhances patient comfort.
The online version contains supplementary material available at 10.1007/s43465-025-01362-0.
在过去十年中，清醒局部麻醉无止血带（WALANT）技术的应用范围已从常见的手部手术扩展到更广泛的一系列复杂手术。然而，尽管其使用频繁，但关于WALANT技术治疗肘管综合征的文献却很有限。我们已将其他同事报道的内镜技术改编为一种迷你开放手术方法。这种方法的特点是切口较小，同时保留其血供。我们的目的是描述这种两阶段局部麻醉注射方法，该方法使我们能够安全、成功地治疗16例患者且无并发症。
我们进行了一项回顾性队列研究。16例符合特定纳入标准的患者在WALANT技术下行尺神经减压术。患者术前根据德龙分类法进行分类。手术技术包括分阶段局部麻醉溶液浸润和仔细解剖以保持神经稳定性。
术前分类显示，轻度6例，中度6例，重度4例。在加入第二阶段远端局部麻醉浸润之前，有4例患者报告术中不适。所有患者术中尺神经定位均稳定，术后20分钟可独立出院。平均随访12周（范围10 - 18周）显示所有患者症状均缓解。未报告任何并发症，包括对前臂内侧皮神经分支的医源性损伤。
本研究证明了WALANT技术用于肘部尺神经减压的可行性和有效性。采用分阶段局部麻醉浸润可提高患者舒适度。
在线版本包含可在10.1007/s43465-025-01362-0获取的补充材料。
